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Work summary
• Discourse analysis - complete
• Development of invite letter templates –
•
•
•
•
drafted and feedback gained
Research with parents - complete
Research with HCPs – Late August
Trial and evaluation of interventions Autumn
Sign off and roll out – Spring 11
1
Mapping the linguistic landscape
Media
coverage
from past
year
Focus
group
transcripts
from past
work
• Technical analysis
of language used
around MMR
Parents’
websites
DATA
SOURCES
PCT letters
PCT websites
• Looking for
patterns and
anomalies – largely
qual with some
quant methods
2
MMR = a discourse of fear in media
Emotionally charged metaphors esp. fire, natural
disaster and warfare
o “Unlike most scientific controversies which
flare up and die away, however, this one has
simmered for a decade - and may now be
fired up again by the preliminary verdicts in
the GMC case.” (Independent)
“Wakefield ... published his research ... which
unleashed a tsunami of fear about MMR.”
(Times)
o “His research paper ... sent shockwaves
across the world of medicine and into the
homes of families” (BBC News)
o “I was there when Wakefield dropped his
bombshell” (Independent)
o “The Lancet knew it had a potentially
explosive paper on its hands.” (Independent)
o “...battle over the safety of the MMR vaccine”
(Times)
This tendency
more
pronounced
than in average
media
coverage:
reflects the
location of
MMR across
ideological
tensions and
fault lines
3
‘The (misguided) middle classes’
vs. ‘the common good’
MMR poses a cultural paradox:
educated people are rejecting a)
science and b) the common good
‘…middle-class twits like
Joanne pottering around
the kitchen brewing up
potions‘ (Mail)
Provokes anxiety and some vicious
attacks e.g. Mail
Reflected in women's own language
– ‘I’m not an evil mother’
[The parents] are middle
class and university
educated, but they are
behaving like morons.
(Mail)
One correspondent - a highly
educated and intelligent woman asserted that girls have died in the
US from the vaccination, and
implying that profit-seeking drug
companies (with the connivance of
governments, presumably) were
prepared to kill our kids in order to
make money. (Times)
4
Ideological tensions:
the ‘big’ cultural context
•Science and
rationality; logic,
reason, evidence,
‘facts’
•Irrationality;
myths, stories,
‘scares’, faith,
belief
•Establishment
authority: top
down,
‘monologic’ voice
•Emerging
authority; peerto-peer authority;
‘dialogue’
‘The public good’
– an intellectual
construction
Vs
.
•Individual, basic,
emotional,
human needs
5
Headline comparison: main differences* between higher
and lower SEG media cont.
Lower SEG media uses simpler language. The language is less varied than
higher SEG data, and there is less use of Latinate terms e.g. ‘immunisation’ (as
we might expect). It is more colloquial – ‘kids’ and ‘mum’ and more
conversational e.g. ‘Well, [Wakefield] didn’t stand a chance did he?’ (Mirror)
Lower SEG features many more human-interest stories: e.g. we see more use of
‘I’ and personal names compared to higher SEG. There is more reference to kinds
of family members in lower SEG than higher SEG, also suggesting human interest
stories.
Parents’ testimonials are an important way that arguments are made or presented
in lower SEG (vs. e.g. use of numbers, authority figures or scientific arguments in
higher SEG); also doctors are more often personalised.
There is less focus on the collective good - ‘protect’ and ‘protected’ always occur
with ‘children’/‘kids’ in lower SEG; while in higher SEG media this also occurs with
‘population’ or ‘individuals’. In addition, lower SEG data does not include abstract
agents like ‘nation’, ‘state’ and ‘society’.
6
The absence of real dialogue – focus group
transcripts
“...if you go to the clinic they’ll just
say, why hasn’t he had his
vaccinations, and they’ll start
scaring you, saying there is
measles around. They kind of take
that approach with you. They
don’t say ‘have you got any
concerns about it, or why...’ . I
don’t find that that helpful,
really.” (Depth 1)
“You don’t actually need to go into all of
this. That could have been small and even
more punchy. You know, ‘Don’t leave your
child’s health to chance. Just get the
immunisation!’” (Immunisation Officer)
“[the doctor] turned round and she said ‘Oh some
people have been like, you know, looking at what
these celebrities do and think that they can come
into here and …’ and that was a little rant. And I
was like ‘oh my God how can you say this to me?’ I
am a mother, you see my child, you see that I am
concerned. I am not crazy, I am speaking to you
nicely” (Depth 4)
“Just basically them trying to convince us to
allow my little girl to have it but obviously I’ve
raised the same issues that I’ve raised here
and, you know, they can’t give you that
information [re: the risks of MMR] because
half the time they don’t know it themselves.
You know, to me, they’re like robots
basically” (Depth 7)
7
Parents’ (i.e. mums’) websites
Amplified version of the tensions seen in other areas
Highly emotional esp. mumsnet.com; MMR a highly contested subject
Gendered – one poster ‘accused’ of being male through tone of his/her argument
Mums’ own research can be deep and highly specific – they post academic
articles for others to read
Scathing about NHS ‘party line’ - and brutally to the point: “Measles being
dangerous does not make MMR safe”
Longing for real information, but within a dialogue – have to look to the peer group
for this, but room for DH to take a different approach
I can see why they might not want a measles epidemic, but if tactics so far
haven't worked to increase numbers then perhaps they should try another.
They have been shouting the MMR is safe line for years, Wakefield's reputation
is now destroyed. If people still refuse MMR then maybe they need to look at
why and approach the public differently (mumsnet.com post 24th Feb 2010)
8
Implications for interventions:
thoughts from the discourse perspective
Engage in dialogue – properly
• Conversations, not ‘messages’
• Extrapolate from mediation, conflict management and negotiation; need
first to show adversaries that they are heard and respected by each
other
Construct a different relationship between health care providers (and the
institutions behind them) and parents, esp. mothers
• not parent/child – ‘we know best’ – clearly not working
• nor a gendered asymmetry of power – clearly retrogressive
• BUT an adult-adult, respectful
• and/or use a more human approach, replacing institutional authority
with peer authority (this suggestion comes from looking at the lower
SEG media data)
NB implications for ‘behaviour change’
• BUT in HCPs and ‘authority voices’ – not just in parents.
9
PCT letters: seem unlikely to connect with parents
Obligation prominent; pressurising without recognising where parents
start from
Cumbersome and stilted; poor grammar, spelling and punctuation could
make the sender seem untrustworthy to educated parents
In addition: some problems common in public sector comms:
• Sense of self-absorption and lack of focus on the reader
• Concerned with own official discourse, not what will make most sense
to readers
• Clash between the private world of the parent and the public sphere of
health institutions
10
Parents focus groups – top line interim
findings
Four groups held in Newham and Kensington & Chelsea early august 2010
Barriers to uptake
Feeling that HCPs don’t have time to discuss concerns and in some cases not
willing / able to
Overall experience of immunisations generally can be negative, some
uncomfortable ‘holding down’ children whilst injection given and would rather
other HCP does this (but others want to do themselves)
Environment where immunisations given not very child friendly / pleasant adding
to negative experience
Some cynicism of NHS who are seen to be driven by targets and payments
MMR in particular seen as a ‘cocktail’ of drugs and concerns about being
unnatural. Link with autism prevalent but not all encompassing
Immunisation schedule is perceived as complex and long and don’t feel have
enough information on it
11
Parents focus groups – top line interim
findings
Potential interventions
HCP training to ensure willing / able to address parents
concerns and ability to spend time with concerned parents
Possibility of other HCP holding child whilst injection given
Environment where immunisations given softer with toys etc.
Work with respected children's charities to communicate
benefits of immunisations
Review information provided to new parents to assess
usefulness. Is different format useful. But, are parents
receptive. Timing